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Antipsychotic Shows Promise in Treating Cancer-Related Anorexia: Presented at ASCO

By Ed Susman

CHICAGO -- June 2, 2008 -- The antipsychotic drug olanzapine may help patients with cancer-related anorexia regain weight, researchers noted here at the American Society of Clinical Oncology (ASCO) 44th Annual Meeting.

"The combination of megestrol acetate 800 mg a day and olanzapine 5 mg a day appears to be an effective intervention for patients with cancer-related anorexia," said Rudolph M. Navari, MD, Walther Cancer Research Center and Indiana University School of Medicine, South Bend, Indiana, speaking here at a poster presentation on May 31.

Dr. Navari recruited 80 individuals who had lost at least 5% of their stable, pre-illness body weight into a study to test whether the combination of megestrol acetate and olanzapine could aid in weight gain more than megestrol acetate alone.

Among the 76 patients who were evaluable in the 8-week trial, at least a 5% weight gain was achieved by 35 of the 39 patients on the combination of drugs, a significant difference (P < .01) from baseline. He said 19 of the 37 patients receiving megestrol acetate alone were able to maintain weight loss, but that did not reach statistical significance compared to baseline figures for the group, Dr. Navari said.

At the end of the trial, 25% of the patients taking olanzapine reported appetite improvement, compared with 3% of those on megestrol acetate alone; 23% of those on olanzapine said they had an improvement in symptoms of nausea compared with 5% of those on megestrol acetate alone.

Twenty-five percent of those taking olanzapine also reported an improved quality of life compared with 6% of those on megestrol acetate monotherapy.

All of these differences were statistically significant (P < .01).

Dr. Navari noted that one of the unwanted side effects of olanzapine among patients taking the drug for control of schizophrenia has been weight gain. He suggested that in this particular population, the unwanted side effect could actually be positive.

"Cancer-related anorexia and weight loss are major clinical problems in up to 70% of patients with advanced disease," said Dr. Navari.

Subjects in this study had a median age of 63 years (range: 39-81 years). There were 37 women and 43 men in the study, about half of whom were white. Thirty-five patients had colon cancer and 45 had lung cancers.

Patients were excluded if they had undergone major surgery, chemotherapy, or radiotherapy in the previous 4 weeks, had active dysphasia or gastrointestinal-tract obstruction, or were receiving systemic corticosteroids. Patients were assessed weekly using the M.D. Anderson Symptom Inventory (MDASI) with specific measurement of weight, appetite, nausea, and quality-of-life measures.

Megestrol acetate administration traditionally has resulted in weight gain among some patients with cancer-related anorexia who were battling advanced stage 3 or stage 4 gastrointestinal or lung cancer.

Olanzapine has been used to combat chemotherapy-induced nausea and vomiting.

[Presentation title: Treatment of Cancer Related Anorexia With Olanzapine and Megestrol Acetate. Abstract 9576]

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